It is a fact of life that dental disease can cause pain, and unfortunately many people suffer toothache in their lives at one time or another. The answer is, of course, to seek treatment at the earliest opportunity but there are effective analgesics (painkillers) that can be used to control toothache.
Pain can be caused by any one of a number of conditions (read more on the causes here) such as caries (dental decay), a cracked or broken tooth, a fractured filling, exposed dentin, peri-apical infection (abscess), pulpitis (inflamed tooth “nerve”), sinusitis, pericoronitis, acute ulcerative gingivitis, a dry socket, or temporo-mandibular joint (TMJ) problems.
Types of “analgesics”
The two main groups of analgesics (medical name for painkillers) are opioid and non-opioid. The former are also referred to as narcotics, such as morphine derived from opium and are very powerful. Increasing doses give increasing pain relief but there are other potentially dangerous side effects to consider at high doses and these types of drugs are not commonly used in dentistry; and if they are used it is only for a short period of time, because of the dangers of side effects or addiction.
Non-opioid analgesics are generally used to control dental pain until definitive treatment can be instigated, and as an adjunct to dental treatment, either pre-or post-operatively. There is good evidence that taking, say, a dose of ibuprofen before a dental procedure will considerably reduce post-operative pain – by blocking the production of pain inducing chemicals in the body.
Analgesics work either by reducing inflammation or by diminishing the brain’s perception of pain through the nervous system. It is often useful to combine two different types of painkillers to increase the pain relieving effect whilst keeping side effects to a minimum.
A warning note – Always stick to the dose prescribed or on the box (if bought over the counter). Certain medications cannot be taken by different groups of patients, especially if you take other drugs or have other medical problems. If in any doubt always seek professional advice prior to taking any medications. Better safe than sorry!
The main types of non-opioid analgesics are:
Aspirin is the best known and most commonly used salicylate and it also helps reduce inflammation and fever. Another feature of interest to dentists and patients, when extraction of teeth is necessary, is diminished blood clotting or “thinning” of the blood which has to be taken account of. So aspirin is generally not advised for post-operative pain relief following an extraction or other dental surgery.
Non-steroidal anti-inflammatory drugs (NSAIDs)
This is a group of painkillers which are similar to aspirin in their mode of action, their pharmacological effects, and adverse reactions.
They have a powerful pain relieving effect as well as anti-inflammatory action. They are considerably safer than opioids and can be used to control mild to moderate pain which makes them most useful in dentistry.
NSAIDs are available in varying strengths, some being available without prescription. The maximum effective dose of ibuprofen is 400-800 mg at any one time and higher doses do not have a benefit as far as dental pain relief is concerned. In general a dentist will only prescribe higher doses when there is swelling apparent, as well as pain and the anti-inflammatory effect is important.
Ibuprofen is commonly used in association with paracetamol for toothache pain relief, even of quite severe pain, providing an added anti-inflammatory effect. Because paracetamol works in a different way it can be safely combined with a NSAID such as ibuprofen. Ibuprofen is generally well tolerated and only produces some gastro-intestinal upset in a small percentage of patients. Ibuprofen can reduce the blood thinning effect of aspirin so patients taking aspirin for cardiovascular protection should avoid it.
Diclofenac is another potent NSAID, as is also aceclofenac which may cause less gastrointestinal side effects.
Acetaminophen or paracetamol
Acetaminophen/paracetamol acts more centrally, to block the pain messages in the brain and has little effect in reducing inflammation but is an effective medicine for toothache. It is useful for those who can’t take aspirin or it can be combined with aspirin or a NSAID to greater effect.
A dose of 4-500 mg is commonly used and adequate, although the maximum effective dose for toothache relief is about 1000 mg. An excessive amount of acetaminophen can potentially cause liver damage so this needs to be taken into account, especially when analgesic products combining two or three types are used. Only when the dose of NSAID and/or paracetamol is at optimum levels, is it usually necessary to consider adding an opioid, and this is fairly rare in most dental problem circumstances.
Dental pain can be miserable and very debilitating, since it may make eating or sleeping difficult, and so relief of pain is essential. As it is not always possible to get immediate definitive dental treatment, it is indeed fortunate that we have effective drugs to make the situation bearable. Analgesics are also extremely useful to control pain after essential dental operations are carried out in many cases.
The key to successful toothache management is proper diagnosis of the cause, and then correct treatment together with adequate pain relief as necessary. In general, NSAIDs and paracetamol can adequately control the pain of toothache and have (for most patients) little or no side effects in the doses normally prescribed.